Taking care of critically ill patients involves caring for their families as well. Family conferences could be time consuming or even frustrating, yet they are an essential part of our practice. It becomes even more challenging when you are caring for the patient who is unable to come off mechanical ventilation. Those patients often end up with tracheotomy tube (click on image above) to facilitate weaning from a ventilator. Sometimes, patients spent weeks or even months on a Vent and this is what we call prolonged mechanical ventilation (PMV).
Recent paper by Cox et al in Critical Care Medicine “Expectations and outcomes of prolonged mechanical ventilation” indicates that only 9% of patients were alive and could function independently one year after their treatment in ICU involving PMV. This is shocking. What even more shocking was the extent of miscommunication between families and physicians reported in this study. I agree that families often have unrealistic expectations regarding outcomes of critical illness. I also agree that we as physicians often fail to effectively communicate this information to the families. There are multiple reasons for that. Sometimes, you have a “difficult” family and you simply cannot “get through to them”. It happens, but that is only part of the problem. Physicians are often focused on short term prognosis and outcome. Getting somebody off the Vent and out of the Unit is an improvement, right? May be yes, maybe not, and we should help families to decide this.
Based on this article, we should a better job of talking to the families of critically ill patients.